BACKGROUND: The psychosocial work environment in healthcare is widely recognized as challenging. High workload, stress, and poor work-life balance contribute to negative health outcomes for healthcare workers. Swedish primary healthcare faces similar issues, yet efforts to address them have focused primarily on individual-based interventions, such as stress management. Research on organizational initiatives remains limited, despite their greater potential for achieving long-term, sustainable improvements.

AIM: This study aims to explore characteristics of primary healthcare units where organizational initiatives to improve the psychosocial work environment have been successfully carried out.

METHODS: A multiple case approach was used, allowing various cases to be investigated and enabling identification of similarities and common patterns across the units.

RESULTS: Four main categories and 16 subcategories were identified, capturing key factors that contribute to a favorable psychosocial work environment in primary healthcare through organizational initiatives. The main categories are engaged leadership, an open workplace climate, conditions for improvement, and a structured work organization.

CONCLUSION: This study identifies key characteristics of primary healthcare units that contribute to creating a favorable psychosocial work environment in Swedish primary healthcare. These elements promote inclusivity, balanced change processes, and staff involvement in decision-making. The findings underscore the need for further research on managerial challenges and effective strategies for staff recruitment and retention.

Implementation science has seen the development of literally hundreds of theoretical approaches in the form of theories, models and frameworks for use by researchers in the field. This chapter provides an overview of the theories, models and frameworks that are available in implementation science, with the aim of describing how these approaches are applied. The chapter presents a taxonomy that distinguishes between different approaches to advance clarity and achieve a common terminology in the field. Knowledge about the theories, models and frameworks facilitates appropriate selection and application of relevant approaches in implementation science studies.

Background Alcohol screening and brief intervention (SBI) is an evidence-based intervention recommended by the World Health Organization. This study applied the Consolidated Framework for Implementation Research (CFIR) to understand facilitators and barriers of SBI implementation in primary care settings in Hong Kong, China.Methods This was a sequential mixed-method study. In-depth interviews of 21 physicians and 20 nurses working in the primary care settings from the public and private sectors were first conducted to identify CFIR constructs that were relevant to SBI implementation in the Chinese context and potential factors not covered by the CFIR. A questionnaire was then developed based on the qualitative findings to investigate factors associated with SBI implementation among 282 physicians and 295 nurses.Results The in-depth interviews identified 22 CFIR constructs that were facilitators or barriers of SBI implementation in Hong Kong. In addition, the stigmatization of alcohol dependence was a barrier and the belief that it was important for people to control the amount of alcohol intake in any situation was mentioned as a facilitator to implement SBI. In the survey, 22% of the participants implemented SBI in the past year. Factors associated with the SBI implementation echoed most of the qualitative findings. Among physicians and nurses in both sectors, they were more likely to implement SBI when perceiving stronger evidence supporting SBI, better knowledge and self-efficacy to implement SBI, more available resources, and clearer planning for SBI implementation in the clinics but less likely to do so when perceiving SBI implementation to be complicated and of higher cost, and drinking approved by the Chinese culture. Participants were more likely to implement SBI when perceiving SBI fit better with the existing practice and better leadership engagement in the public sector, but not in the private sector. Perceiving a stronger need and greater importance to implement SBI were associated with higher likelihood of SBI implementation among physicians, but not among nurses. Perceiving better organizational culture supporting SBI was positively associated with SBI implementation among nurses, but not among physicians.Conclusions There was a significant gap between SBI evidence and its implementation. Some strategies to improve SBI implementation may be different between physicians and nurses and between those in the public and private sectors. The CFIR is a useful framework for understanding facilitators and barriers of SBI implementation in primary care settings.

Determinant frameworks are used in implementation science to describe and categorize influences (i.e. determinants) on the implementation of evidence-based practices. Determinants are typically divided into barriers (or hindrances) and facilitators (or enablers or drivers) of implementation. Knowledge about implementation determinants is important to develop and select appropriate strategies to overcome barriers and harness facilitators to support the implementation of evidence-based interventions, programmes, services and other practices. This chapter looks at the origins, content and use of six determinant frameworks.

Background: There is overwhelming evidence for the preventive effects of regular physical activity and healthy eating habits on the risk for developing a non-communicable disease (NCD). Increasing attention has been paid to community-wide approaches in the battle against NCDs. Communities can create supportive policies, modify physical environments, and foster local stakeholder engagement through intersectoral collaboration to encourage communities to support healthy lifestyles. The Pep initiative is based on intersectoral community-wide collaboration among Sweden’s municipalities. Primary targets are municipality professionals who work with children and young people as well as parents of children <18 years. The goal is to spread knowledge and create commitment to children’s and young people’s health with a special focus on physical activity and healthy eating habits to facilitate and support a healthy lifestyle. The overarching aim of the research project described in this study protocol is to investigate factors that influence the implementation of the Pep initiative in Sweden, to inform tailored implementation strategies addressing the needs and local prerequisites of the different municipalities.

Methods: The project includes a qualitative and a quantitative study and is framed by a theoretical model involving four complementary forms of knowledge, explicitly recognized in the Pep initiative: knowledge about the issue; knowledge about interventions; knowledge about the context; and knowledge about implementation. Study 1 is a focus group study exploring barriers and facilitators for implementing the Pep initiative. The study will be carried out in six municipalities, selected purposively to provide wide variation in municipality characteristics, including population size and geographical location. Data will be analyzed using thematic analysis. Study 2 is a cross-sectional web-based survey investigating the implementability of the Pep initiative in Sweden’s 290 municipalities. Conditions for implementing different areas of the Pep initiative will be examined in terms of the acceptability, appropriateness, and feasibility, three predictors of implementation success. Data will be analyzed using non-parametric statistics.

Discussion: The findings of the two studies will increase understanding of the prerequisites for implementing the Pep initiative in Swedish municipalities, which will provide valuable input into how implementation of the Pep initiative can best be facilitated in the different municipality settings.

Background Implementation science in health is an interdisciplinary field with an emphasis on supporting behavior change required when clinicians and other actors implement evidence-based practices within organizational constraints. Behavioral economics has emerged in parallel and works towards developing realistic models of how humans behave and categorizes a wide range of features of choices that can influence behavior. We argue that implementation science can be enhanced by the incorporation of approaches from behavioral economics. Main body First, we provide a general overview of implementation science and ways in which implementation science has been limited to date. Second, we review principles of behavioral economics and describe how concepts from BE have been successfully applied to healthcare including nudges deployed in the electronic health record. For example, de-implementation of low-value prescribing has been supported by changing the default in the electronic health record. We then describe what a behavioral economics lens offers to existing implementation science theories, models and frameworks, including rich and realistic models of human behavior, additional research methods such as pre-mortems and behavioral design, and low-cost and scalable implementation strategies. We argue that insights from behavioral economics can guide the design of implementation strategies and the interpretation of implementation studies. Key objections to incorporating behavioral economics are addressed, including concerns about sustainment and at what level the strategies work.Background Implementation science in health is an interdisciplinary field with an emphasis on supporting behavior change required when clinicians and other actors implement evidence-based practices within organizational constraints. Behavioral economics has emerged in parallel and works towards developing realistic models of how humans behave and categorizes a wide range of features of choices that can influence behavior. We argue that implementation science can be enhanced by the incorporation of approaches from behavioral economics. Main body First, we provide a general overview of implementation science and ways in which implementation science has been limited to date. Second, we review principles of behavioral economics and describe how concepts from BE have been successfully applied to healthcare including nudges deployed in the electronic health record. For example, de-implementation of low-value prescribing has been supported by changing the default in the electronic health record. We then describe what a behavioral economics lens offers to existing implementation science theories, models and frameworks, including rich and realistic models of human behavior, additional research methods such as pre-mortems and behavioral design, and low-cost and scalable implementation strategies. We argue that insights from behavioral economics can guide the design of implementation strategies and the interpretation of implementation studies. Key objections to incorporating behavioral economics are addressed, including concerns about sustainment and at what level the strategies work.Background Implementation science in health is an interdisciplinary field with an emphasis on supporting behavior change required when clinicians and other actors implement evidence-based practices within organizational constraints. Behavioral economics has emerged in parallel and works towards developing realistic models of how humans behave and categorizes a wide range of features of choices that can influence behavior. We argue that implementation science can be enhanced by the incorporation of approaches from behavioral economics. Main body First, we provide a general overview of implementation science and ways in which implementation science has been limited to date. Second, we review principles of behavioral economics and describe how concepts from BE have been successfully applied to healthcare including nudges deployed in the electronic health record. For example, de-implementation of low-value prescribing has been supported by changing the default in the electronic health record. We then describe what a behavioral economics lens offers to existing implementation science theories, models and frameworks, including rich and realistic models of human behavior, additional research methods such as pre-mortems and behavioral design, and low-cost and scalable implementation strategies. We argue that insights from behavioral economics can guide the design of implementation strategies and the interpretation of implementation studies. Key objections to incorporating behavioral economics are addressed, including concerns about sustainment and at what level the strategies work.Conclusion Scholars should consider augmenting implementation science theories, models, and frameworks with relevant insights from behavioral economics. By drawing on these additional insights, implementation scientists have the potential to boost efforts to expand the provision and availability of high quality care.

Conducting implementation science research involves critical decision making on the methods for data collection and analysis as well as the study design that would best answer the research question of interest. This chapter reviews several research methods and study designs used in implementation science research. The chapter begins with an overview of qualitative, quantitative and mixed methods for identifying and/or assessing barriers and facilitators to implementing an evidence-based practice. The second part of the chapter looks at different study designs for carrying out studies to evaluate the effectiveness of different strategies to overcome barriers and harness facilitators.

"This core textbook introduces the key concepts, theories, models and frameworks used in implementation science, and supports readers applying them in research projects. The first part of the book focuses on the theory of implementation science, providing a discussion of its emergence from the evidence-based practice movement and its connections to related topics such as innovation research. It includes chapters looking at a wide range of theories, methods and frameworks currently used in implementation science, and a chapter focusing on suitable theories that could be imported from other fields. The first part also addresses strategies and outcomes of implementation and discusses how researchers can build causal pathways adapted to their study. The second part of the book focuses squarely on putting the theory of implementation science to work in practice, with chapters discussing research methods used in the field and how to select the most appropriate approach. This section is rounded off by eight chapters presenting in-depth case studies of specific applications. This multidisciplinary text is an essential resource for graduate students taking courses on implementation science from a range of healthcare backgrounds, as well as researchers from medicine, nursing, public health, allied health, economics, political science, sociology and engineering"--

Implementation strategies have been defined as methods or techniques that are used to enhance the adoption, implementation and sustainability of evidence-based practices in healthcare and other settings. An overview of some taxonomies that categorize different types of implementation strategies is provided. The chapter also deals with the matching of determinants with the appropriate strategies, which represents a considerable challenge in implementation science. Some tools and methods to facilitate this matching process are described. Implementation outcomes, defined as the effects of deliberate and purposive actions to implement evidence-based practices, are also addressed. They are distinct from patient or population outcomes. Two commonly used implementation outcome taxonomies are described.